Transcendent Health Clinic: RESEARCH CLINIC APPLICATION
SECTION I: APPLICANT INFORMATION
Date of Birth
Permanent Residential Address
Current Residential Address
Country of Citizenship
SECTION II: RESEARCH CLINIC INFORMATION
Please select the condition that applies to what you are healing from:
SECTION III: APPLICANTS DECLARATION & SIGNATURE
This research clinic provides holistic healing treatment at no cost in exchange for your written reflections on the process. I authorize Indigo International, acting on behalf of Transcendent Health Clinic to collect, use and disclose data and information I share about my healing.
I understand that if I should be accepted into this research clinic, monthly holistic healing treatments are awarded as part of a grant from Indigo Education Foundation. The grants are provided for a period of 12 - 36 months. Therefore, upon acceptance into the research clinic I agree to commit myself to this healing process for at least 12 and up to 36 months.
Typing your name in the box below acts as your signature of this application.
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